Experimental percutaneous extrahepatic portacaval shunt creation by transjugular approach in swine

Chang Kyu Seong, Dusan Pavcnik, Barry T. Uchida, Hiroshi Anai, Hans Timmermans, Mahtab Niyyati, Christopher L. Corless, Luiz O. Correa, Frederick S. Keller, Josef Rösch

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

The purpose of the study was to evaluate the feasibility of the creation of a percutaneous extrahepatic portacaval shunt (PEPS) in swine by a transjugular approach and to find a suitable stent-graft to use in PEPS. In 12 swine, the extrahepatic portal vein (PV) was entered from the inferior vena cava (IVC) by a needle system introduced from the transjugular approach. A catheter introduced through the transhepatic approach served as a target. Five types of stent-graft consisting of homemade Z stents and a polytetrafluoethylene cover were explored for PEPS creation. Eight animals had follow-up venograms up to 6 weeks or until the shunt became severely stenotic. Gross and histologic examinations were performed after the final follow-up venography. The PV punctures and stent-graft placement were difficult, but the PEPS was established in all animals. In four animals, the stent-graft failed to adequately cover the tract, causing severe hemorrhage. Only two shunts remained patent up to 6 weeks. The other shunts exhibited severe stenosis or occlusion. At gross examination, all shunts traversed the liver parenchyma of the caudate lobe surrounding the IVC. The extravascular PEPS portion was 4 mm to 2 cm long. All shunts entered the PV close to the splenomesenteric junction and exhibited neointimal formation. Shunt stenoses were caused by neointimal hyperplasia and occlusions by a superimposed thrombus. PEPS can be created by the transjugular approach in swine, but only the PV shunt entrance is extrahepatic. None of the tested rigid stent-grafts were suitable for PEPS creation. A short flexible stent-graft with flanged ends is suggested for further exploration.

Original languageEnglish (US)
Pages (from-to)616-623
Number of pages8
JournalCardiovascular and interventional radiology
Volume28
Issue number5
DOIs
StatePublished - Jun 1 2005

Keywords

  • Experimental studies
  • Interventional procedures
  • Portacaval
  • Prosthesis
  • Shunts
  • Stent-grafts
  • Stents

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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